第一次抗精神病藥物的使用增加年輕工人的急性腦心血管疾病的風險

First Prescription of Antipsychotics Increases Risks of Acute Cardiovascular Disease in Young Workers

陳亮憲(Liang-Sien Chen) ； 莊海華(Hai-Hua Chuang)

《中華職業醫學雜誌》 28卷1期 (2021/01) Pp. 45-53

摘要

背景：在過去的十年已有報告，抗精神病藥物處方使用與中風或急性心肌梗塞的副作用之間存在相關性。但我們尚不知道接受抗精神病藥物處方後，年輕工人是否會增加患急性腦心血管疾病的風險。我們的目的是探討首次使用抗精神病藥物的處方是否會增加年輕工人的急性腦心血管疾病風險。方法：我們分析了2000年至2013年台灣國家衛生研究院（NHRID）的健保資料庫。我們只收案二十歲至四十歲的年輕人口，並以首次使用抗精神病藥物為暴露、首次診斷為腦心血管疾病為結果。該方法學是自我控制案例系列研究方法（SCCS），該方法使用條件卜瓦松迴歸分析。我們計算了發病率和風險期與控制期之間的95％信賴區間，並對年齡進行了每兩年分層調整。結果：在整個研究期間，有917例有首次中風，408例有首次急性心肌梗塞，205例有首次肺栓塞或靜脈血栓栓塞。與對照組相比，第一年中風的發生風險有顯著增加（IR 2.18；95％CI: 1.76-2.71）；第二至第三年中風風險（IR 1.51； 95％CI: 1.22-1.88），第四至第五年中風風險（IR 1.28； 95％CI: 0.95-1.72）。與對照組相比，在第一年的急性心肌梗塞的風險顯著增加（IR 2.0； 95％CI: 1.42-2.28）；第二至第三年急性心肌梗塞的風險（IR 1.64； 95％CI:1.2-2.24），第四至五年急性心肌梗塞的風險（IR，1.5； 95％CI，0.99-1.72）。與對照組相比，在第一年的肺栓塞或靜脈血栓栓塞風險顯著增加（IR 2.15； 95％CI，1.36-3.4）；第二至第三年靜脈血栓栓塞風險（IR 0.88； 95％CI: 0.5-1.56），第四至五年靜脈血栓栓塞風險（IR 1.6； 95％CI: 0.9-2.83）。結論：我們發現二十歲至四十歲的年輕工人急性心血管疾病與抗精神病藥物的使用之間存在關聯，並且在首次處方抗精神病藥物後的第一年之間的急性腦心血管疾病的發生率最高。今後應探討急性腦心血管疾病與抗精神病藥物之間的藥理作用機理。

關鍵字

抗精神病藥物 ； 中風 ； 急性心肌梗塞 ； 靜脈血栓栓塞 ； 年輕工人

並列摘要

Background: The association between prescription of antipsychotics and side effects of stroke or acute myocardial infarction have been reported in the past decade. However, little is known whether young adults have increased risk of acute cardiovascular disease following prescription of antipsychotics. The aim of this study is to investigate whether first prescription of antipsychotics increases risk of acute cardiovascular disease in young workers. Methods: We analyzed Taiwan National Health Research Institute database (NHRID) from 2000 to 2013. Subjects aged from 20 to 40 years old with a concurrent diagnosis of first prescription of antipsychotics (as the exposure) and first-ever acute cardiovascular event (as the outcome) were enrolled. The method applied for this study was Self-Controlled Case Series study (SCCS), which uses conditional-Poisson regression. We calculated the incidence and the 95% confidence interval between risk period and control period with two-year stratification of age adjustment. Results: During the entire observation period, 917 individuals had first-ever stroke, 408 individuals had first-ever acute myocardial infarction, and 205 individuals had first-ever pulmonary embolism or venous thrombo-embolism. The incidence of stroke was significantly increased in the first year of risk versus control (IR, 2.18; 95% CI, 1.76-2.71), 2^(nd) to 3^(th) year (IR, 1.51; 95% CI, 1.22-1.88), 4^(th) to 5^(th) year (IR, 1.28; 95% CI, 0.95-1.72). The incidence of acute myocardial infarction was significantly increased in the first year of risk versus control (IR, 2.0; 95% CI, 1.42-2.28), 2^(nd) to 3^(th) year (IR, 1.64; 95% CI, 1.2-2.24), 4^(th) to 5^(th) year (IR, 1.5; 95% CI, 0.99-1.72). The incidence of venous thrombo-embolism was significantly increased in the first year of risk versus control (IR, 2.15; 95% CI, 1.36-3.4), 2^(nd) to 3^(th) year (IR, 0.88; 95% CI, 0.5-1.56), 4^(th) to 5^(th) year (IR, 1.6; 95% CI, 0.9-2.83). Conclusion: We reported the association between acute cardiovascular disease in young workers and prescription of antipsychotics. The highest incidence of acute cardiovascular disease was in the first year after first prescription of antipsychotics. Future investigations on the underlying mechanisms of the interactions between acute cardiovascular disease and antipsychotics are warranted.

並列關鍵字

Antipsychotics ； Stroke ； Acute Myocardial Infarction ； Venous Thrombo-embolism ； Young Worker